Provider Demographics
NPI:1437141090
Name:FONER, BARBARA JOY (MD MPH FCCP ABSM)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JOY
Last Name:FONER
Suffix:
Gender:F
Credentials:MD MPH FCCP ABSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6812 STATE RTE 162 SUITE 202
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062
Mailing Address - Country:US
Mailing Address - Phone:618-288-6844
Mailing Address - Fax:618-288-6852
Practice Address - Street 1:6812 STATE RTE 162 SUITE 202
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062
Practice Address - Country:US
Practice Address - Phone:618-288-6844
Practice Address - Fax:618-288-6852
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109204207RC0200X, 207RP1001X
IL036-105231207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1437141090Medicaid
MO991390091Medicare PIN
MO1437141090Medicaid